# Musculoskeletal Pain as a Risk Factor for Poor Dizziness Outcomes: A Longitudinal Study Among Patients With Persistent Vestibular Dizziness

## TL;DR

This study shows that musculoskeletal pain worsens dizziness outcomes, especially when combined with psychological distress.

## Contribution

The study identifies musculoskeletal pain as a risk factor for poor dizziness outcomes and highlights the role of psychological distress.

## Key findings

- Patients with more pain sites and higher pain intensity had worse dizziness outcomes.
- Psychological distress strengthens the negative impact of pain on dizziness.
- Severe dizziness persisted in patients with ≥4 pain sites or pain intensity ≥4 for 12 months.

## Abstract

Musculoskeletal pain and psychological distress are prevalent comorbidities in patients with persistent dizziness. Little is known about how comorbid pain influences the outcome of persistent dizziness. This study examined the impact of pain on dizziness outcomes and the potential modifying role of psychological distress.

This study was a longitudinal study of 150 patients with persistent dizziness. Vertigo Symptom Scale - short form (VSS-SF), Dizziness Handicap Inventory (DHI), number of pain sites, pain intensity, and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, 6 months and 12 months. Linear mixed effects model for longitudinal data was used to explore the association between musculoskeletal pain and dizziness. Interaction analysis was used to assess whether psychological distress had a modifying effect on the association between pain and dizziness.

VSS-SF and DHI decreased during follow-up but not to a clinically relevant level for the patients. Patients reporting comorbid psychological distress reported higher scores on VSS-SF, DHI, more pain sites and higher pain intensity. A positive association was observed between the number of pain sites and VSS-SF and between pain intensity and VSS-SF, and these associations were stronger in patients reporting psychological distress. Similar associations were found for DHI. Patients reporting ≥4 pain sites or pain intensity of ≥4 out of 10 at baseline, still reported severe dizziness and moderate disability 12 months later.

Musculoskeletal pain is a risk factor for poor dizziness outcomes, especially when comorbid psychological distress is present. Clinicians should be attentive to musculoskeletal pain when the number of pain sites exceeds 4 or pain intensity exceeds 4 on a numeric rating scale.

A new understanding of the impact of musculoskeletal pain on persistent dizziness could be the key to successful recovery and the prevention of prolonged issues.